Dementia and Proton Pump Inhibitors

Dementia is a progressive, degenerative disease of the brain that describes a wide set of symptoms including:

impaired long and short-term memory

Language problems

emotional problems

Difficulties eating

Vision problems

It affects about 35 million people worldwide, occurs in approximately 10% of individuals and has an economic impact of over £430 billion per year. Its prevalence is highest in people over the age of 85 years. The prevalence of dementia is expected to more than double over the next 15-20 years.

The most common form of dementia is Alzheimer’s disease. One of the most important biological components involved in the development of Alzheimer’s disease is a protein called Amyloid-beta. If these proteins clump together then plaquesform. It is the plaques that are the hallmark of Alzheimer’s disease.

Proton pump inhibitors (PPIs)

PPIs are a class of drugs that acts to reduce the amount of acid produced by the stomach. They are prescribed for in a number of medical conditions including:

Indigestion

Peptic – stomach – ulcers

Acid reflux disease (heartburn)

There use in medicine has increased significantly over the last 10 years especially in the elderly.

The link between them

An article published in JAMA Neurologyin February 2016suggested that using PPIs could increase the incidence of Alzheimer’s disease. The researchers performed a prospective study from 2004 to 2011 on 73,679 individuals aged 75+ without dementia at the outset of the study. They found that individuals who took PPI medication had a significantly increased risk (1.44 times more likely) of developing dementia when compared to the patients not taking the medication. The p-value of this study was <0.001, which means there was less than a one in a thousand chance that these findings were incidental. The risk of developing dementia, associated with PPI use, was found to be higher in men than women.

The authors proposed that the PPIs altered the development of amyloid plaques, resulting in an increased incidence of dementia.

Study limitations: A large number of different factors are known to be associated with dementia including alcohol use, high blood pressure and family history of dementia. These factors were not considered by the study which limits the scientific value of the research.

Additionally, the study did not qualify the type of dementia very well, despite a large number of clinical tests being available to help them do so, nor did they investigate the effect of using different doses of PPIs on the risk-profile.

What do these findings mean for me?

Currently, it is unwise to treat the findings of this paper as definitive. There are significant limitations to the study so it is unlikely that PPIs will be taken off the shelf until more concrete evidence arises.

If you have been advised by your doctor to take PPIs and you are concerned about their health risks it is advisable to speak to your prescribing doctor. However, there are scientifically proven clinical benefits associated with taking PPIs and these should not be ignored in light of this new research.

This research does however encourage doctors to consider more carefully whether the patient really needs PPIs. If there is a clinical indication that a patient should be given PPIs it is likely doctors will continue to prescribe them. If the doctor is unsure whether the patient really needs them, this research may tip the balance in favour of prescribing an alternative drug. Further research must still be conducted, however, to examine this association in more detail.

If you have symptoms which might be due to acid reflux or stomach ulcers, it might be worth seeking an opinion with one of our world-renowned gastroenterology specialists in central London. A clear diagnosis means that you will only take PPI medicines if you need them. A simple endoscopy is usually all that is needed to make a decision on whether this treatment is needed. Call 020 7183 7965 and talk to one of our helpful reception staff to make an appointment.